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The Beneficial Effects Of Physical Exercise Training In Children Sustained Extensive Burns
Ted Huang, MD, Jessica Tanksley, MD, Oscar Suman, PhD, David Herndon, MD.
Shriners Burns Hospital-Galveston, Galveston, TX, USA.

PURPOSE: The regimen of physical exercise ( PEX) prescribed for children who sustained extensive burns has been shown to improve muscle strength, lean body mass, aerobic capacity as well as increase the range of motion in a body joint. Despite these beneficial effects of PEX, the patients will continue to undergo adhesion releasing procedures.
MATERIALS AND METHODS: Between 2003 and 2012, 82 children who sustained burn injuries involving total body surface area (TBSA) in excess of 39% involving the axilla, elbow and the wrist were enrolled in the PEX program consisted of exercise training involved 12-weeks of moderate to intense daily sessions of aerobic treadmill or cycle activities and three times per week sessions of progressive resistance exercise with weights or machines. The records of 115 children sustained similar magnitude of burn injuries but did not participate in the exercise program were retrospectively reviewed. Patients included in both groups were examined by a single surgeon, blinded to patient’s prior treatment regimen, for tightness and movement limitation developed in the axilla, elbow and wrist. A releasing procedure was prescribed for those who were clinically judged to have contractural problems. Demographic differences between exercise groups were assessed by Mann-Whitney and chi-square test where appropriate. A multiple logistic regression model was used to assess the effects upon whether a patient required single or multiple release surgeries due to exercise participation group (PEX versus non-PEX), gender, age, and TBSA.
RESULTS: Subject demographics are summarized in Table 1. There were significant differences between exercise groups in age (p=.026) and gender (p=.010). These differences were adjusted for in the logistic regression model. Twenty-three percent (23%) of patients who received PEX had multiple re-operations versus 77% of the patients who received non-PEX (p = 0.003). Logistic regression (Table 2) results showed that subjects which participated in the PEX exercise program had less than 1/3 the odds (1 over 3.6, 95% CI 1.8-7.3) of requiring multiple release surgeries as compared to subjects involved in the non-PEX program, p=.0003. Male subjects had half the odds of requiring only a single surgery as compared to females (p=.045). Neither age (p=.62) nor TBSA (p=.08) showed significant evidence of a relationship with the number of surgeries required.
SUMMARY: Although the exact reasons for beneficial effects achieved from a regimen of physical exercise in children with extensive burns remain undefined, the frequency of multiple re-operations to release contracted axilla, elbow and the wrist was significantly lower in children who had undergone a short-term intensive physical exercise. We advocate considering implementing an exercise program as supplemental therapy to SOC to improve patient outcomes.

Table 1. Subject demographics

Exercise		non-PEX				PEX
		n	Mean	SD	Median	n	Mean	SD	Median
	Age	115	10.94	3.50	10	82	12.10	3.73	11.5
	Known TBSA	106	62.02	15.71	61.5	79	61.87	17.02	59
Exercise		non-PEX		PEX		Chi Square
		n	%	n	%	p-value
Gender	F	47	40	18	22	0.010
	M	68	60	64	78

Table 2. Logistic regression model summary, with 95% confidence intervals,

	Odds Ratio	CI Min	CI Max	p-value
PEX/non-PEX	3.637	1.812	7.302	0.0003
Male/Female	0.501	0.255	0.984	0.0447
Age	0.978	0.896	1.067	0.6162
TBSA	0.983	0.965	1.002	0.0806

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